Health: Dr Phil Hammond's Column

The press likes to focus on the negative. Of the 3.7 million smears done every year, the vast majority are correctly interpreted by undervalued lab staff working their butts off "Hello doctor. I've been invited for a smear."

"Have you tried the nurse?"

"Bloody typical."

"What?"

"You fanny around on the TV telling women to get informed consent before we have a smear and when I try, you tell me to go and see the nurse."

"I'm sorry. I'm having trouble reconciling my media life with my doctoring."

"My heart bleeds."

"Look, perhaps we should restart the consultation ..."

"Hello doctor. I've been invited for a smear."

"I see. I expect you'll be wanting some informed consent."

"Too bloody right."

"Tell me, what do you understand about cervical screening?"

"I thought it was to stop me getting cervical cancer. But then I read this story in the Evening Post about a 29-year-old woman who had a negative smear, was found to have cancer three months later and died within four months."

"It's very sad, but it doesn't mean there's a fault with the screening programme."

"How can you say that?"

"Because screening never has and never will prevent all cases of cervical cancer. The tragedy is that when young women get the disease, it tends to come on rapidly and be very aggressive, so it is possible to have a negative smear and develop cancer soon afterwards."

"But you hear in the press all the time about laboratories cocking it up."

"Because the press focus on the negative. Of the 3.7 million smears done every year, the vast majority are interpreted correctly by undervalued lab staff working their butts off."

"For what?"

"Screening prevents around half of the cancers, stops some women having radical surgery and radiotherapy for advanced disease, preserves their ability to have children and saves around 1,000 lives a year."

"So why don't you see headlines in the paper saying `Cervical screening saved my life?' "

"Because you can never be sure whose life has been saved."

"Why?"

"Screening picks up risky cells in the cervix which may one day turn into cancer if untreated. Low-risk cells in mildly abnormal smears virtually never progress to cancer and the only treatment needed is a repeat smear in six months' time. If you have moderate-risk cells, about one in 12 may turn into cancer over a number of years, and for high-risk cells it's around one in three. This is thought to be risky enough to offer treatment to all the women with moderate and severe changes - along with those with persistent mild ones - even though most would never develop cancer."

"So a lot of women are getting treatment that may not benefit them?"

"True, but then medical science isn't yet sufficiently advanced to identify exactly who will get cancer, so you have to treat around 50 women to prevent one cancer."

"Still, that's not bad odds."

"Yes, but to find the 50 women, we have to do smears on 4,000, of which 250 will be mildly abnormal."

"But you've already said a mildly abnormal smear is nothing to worry about."

"No, I didn't. I said these changes virtually never progress to cancer."

"Same thing."

"In theory, perhaps. But some women with mild changes are convinced they've got cancer, and worry like stink about it."

"Why?"

"Partly because no one's ever sat down with them to explain that an abnormal smear does not mean cancer. And if they do, it tends to be after they've already had the result, and it's too late to stop the worrying."

"Which is why you're so keen on informed consent before the first smear."

"Especially because mildly abnormal smears are so common - 10 per cent of those in women under 35."

"But that's the price you pay for trying to prevent cervical cancer."

"True, but it's a rare disease anyway. For every woman of screening age who dies from it, I see 10 deaths from heart disease and four from lung cancer. If it was a choice between giving up cigarettes or having smears to live longer, I know which I'd go for."

"So you're saying don't bother?"

"No, I'm saying make your own decision. If you don't mind the procedure and you can cope with the anxiety of an abnormal smear, then go for it. It'll reduce but not stop your already small risk of a very unpleasant disease. But if you think your risk is low and you'd rather not have one, don't feel coerced into it just because I get paid pounds 2,000 for hitting the smear target."

"In that case, I think I'll have one."

"Fine. Have you tried the nurse?"